Consepts

Introduction Shock describes circulatory failure resulting in inadequate tissue perfusion and insufficient delivery of oxygen. Shock is a broad and at times unhelpful term. It refers to any cause of circulatory failure that results in inadequate oxygen delivery to tissues. There are many causes with different underlying pathophysiological processes, normally they are divided into four categories: Hypovolaemic Distributive Cardiogenic Obstructive It should be noted the term ‘shock’ is unliked by many in the medical field. The Royal College of Emergency Medicine describe it as a ‘somewhat lazy shorthand’ preferring clinicians take a more granular approach to their description of the patients clinical state that

Overview Multi-organ dysfunction refers to progressive organ dysfunction whereby homeostasis cannot be maintained without intervention. Multiple organ dysfunction syndrome (MODS), also known as multi-organ failure (MOF), is a severe clinical syndrome that is seen in critically ill patients. It is characterised by progressive organ dysfunction with a failure to maintain homeostasis without intervention. MODS is commonplace in the intensive treatment unit (ITU) setting and usually present at the time of ITU admission and/or at the time of death. MODS is broadly defined as primary or secondary: Primary: direct, identifiable injury (e.g. liver failure due to a hepatotoxic agent) Secondary: no direct

Introduction Examination of the jugular venous pressure provides an estimate of the central venous pressure. Assessment of the jugular venous pressure (JVP) is a normal component of the cardiovascular examination. It is commonly used to help determine a patients’ fluid balance (i.e. do they have too much or too little fluid in the body). This is because the JVP can be used as an indirect marker of central venous pressure (CVP), which is a measure of pressure within the vena cava. The term jugular venous pulse is often used synonymously with jugular venous pressure. To determine the JVP, we have to visualise the

Overview Prescribing intravenous fluids is one of the cornerstone tasks of junior doctors & prescribers. Many patients who are admitted to hospital require intravenous fluids. The task of prescribing intravenous fluids typically falls under the realm of the junior doctor. Becoming proficient at prescribing fluids is one of the key skills during the first year of clinical practice. The indication for fluids can be: Shock (inadequate tissue perfusion) Excess fluid losses (e.g. diarrhoea) Inadequate intake (e.g. nil by mouth) Replacing electrolytes (e.g. potassium) The National Institute of Clinical Excellence (NICE) produced guidelines on the administration of intravenous fluids in both adults and children. However, it is difficult to learn how to

Overview Confirmation of death is an important part of healthcare practice. The confirmation of death is an essential part of practice within both the community and hospital setting. In 2008, the Academy of Royal Medical Colleges issued a generalised code of practice for the confirmation of death. Death may occur from: Irreversible cessation of brain-stem function (i.e. brain-stem death) Following cessation of cardiorespiratory function (including failed resuscitation) The confirmation of brain-stem death (i.e. the heart and lungs can only be maintained by artificial ventilation) is advanced and has to be carried out by at least two medical practitioners (minimum one consultant) who have been registered